Community perception in a vulnerable municipality in the Colombian Pacific

Description

Controlling malaria is costly and epidemics have a negative impact on the socioeconomic development (1) (2). Colombia is endemic for this disease and related to social and economic vulnerability faced by rural areas (3) (4). As a multicausal disease, new approaches to control it must integrate individual participation, community empowerment and institutional leadership (5). Because in Colombia the programs to control the disease have been characterized by a low community participation (6) (7), we need to approach the social construction of health and disease in the endemic population, their collective imagination, needs, and projects (8) (9). Therefore, this study aims to provide a community and institutional view on these elements in relation to the disease and the vector in a community with a long history of social segregation and poverty. The great number of adolescents (55.73%), children (24.89%) and eldery (16.09%) in the community could affect the municipality’s economy, resulting in a small workforce or people forced to work from very early to very advanced ages. Public services are absent or deficient, especially drinking water (33.58%), garbage (65.67%) and sewage disposal (8.21%). All those combine with inequality in the social structure, low-income, gender with inequalities for women and an ethnic group that marks a whole territory of inequality, where Afro-Colombian mixes with the high rurality full of oversight and poverty (10). They know malaria is a disease transmitted by a mosquito and the responsibility to prevent it falls not only on government entities but also on individual and community level. They can identify signs and symptoms; this is in line with other studies in endemic settings from Colombia (11). Some of the field observations showed the lack of control measures and stagnant water, and the use of insecticides and mosquito nets as the most important control measures, being the same reported in other endemic countries (12) (13) (14). To prevent malaria, the health system performs community education; the population accepts it and the level of knowledge is acceptable. However, such methods will not resolve problems regarding the environment which are breeding grounds for high-risk conditions for the population’s health. There is a health center with first level basic care focused on treatment and rehabilitation with few resources. Accessing levels of greater complexity is very difficult due to economic, geographic, and communication barriers, without dismissing the violent actors that are part of daily life. The malaria control programs carried out by the government entities would be focused on effective interventions to address malaria specific risk factors. However, to ensure a health promoting environment in which these populations live and can then practice the appreciate a malaria prevention behaviours, probably a broader a primary care strategy involving a family and community approach is required.

Steps to reproduce

A descriptive observational study was conducted using a knowledge, attitudes, and practices (KAP) survey method in the municipality of Olaya Herrera, located northwest of the Department of Nariño and in the Southwest of Colombia in the Pacific Plain region. The municipal seat of Olaya Herrera is Bocas de Satinga, located at the geographic coordinates of 2°20'52.97" N and 78°19'31.27" W, in the northern sector of the municipal territory, where the Satinga and Sanquianga rivers meet. The “Survey on Knowledge, Attitudes and Practices (KAP) on the approach to malaria in indigenous ​​communities” was conducted with some modifications for its application in the community of Olaya Herrera. It consisted of 41 questions within the variables on basic, general data, KAP about the disease, and perception of health systems, applied to the municipality’s inhabitants. To conduct the surveys, the city map was divided into neighborhoods, from which a random starting point was chosen. The KAP survey was conducted in the first home that was visited, where a resident agreed to participate in the study. The next house visited was the third counting from the previous one, in the clockwise direction, and so on. If an uninhabited house or a vacant lot was encountered, we continued with the next house. At least 60% of the urban area in the municipality was covered before the sample was completed. The inclusion criteria were: people of legal age, municipality residents for at least two years, lived in the house surveyed, and prior informed consent given. The sample size was calculated with a confidence level of 95%, a margin of error of 5%, and an expected malaria amount of 0.05, according to the data reported by the Department of Health of the municipality of Olaya Herrera. Based on these parameters, a minimum sample size of 73 surveys was estimated for residents of the municipality’s urban area. An initial descriptive analysis was made on the KAP survey variables based on frequencies and measures of central tendency depending on the nature of each variable. For the intersection of variables, non-parametric statistics were found by analyzing X2 and Kruskal Wallis. The statistical programs EpiInfo 7.0 and SPSS Statistics V24.0 were used. Additionally, a bivariate analysis was conducted with a focus on social determinants of health. From the data, the descriptive sociodemographic variables were considered as analysis factors (risk/protectors) and as an effect of having contracted malaria or not throughout their life. The data were analyzed in 2x2 contingency tables and OR incidence was calculated, seeking to delimit the variables most likely associated with having the disease or not, from the social determinants. A value of p < 0.05 was considered significant in the X2 tests and values different than 1 in IC95%.

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